The Crime

Cookies, candy, breakfast cereal, and ice cream may be sweet, but they aren't the largest source of daily calories for adults and kids. That honor goes to sugar-sweetened beverages. Sugar-sweetened beverages, or SSBs, are at the center of much debate in obesity research these days. More and more studies support an association between SSB consumption and heightened caloric intake, weight gain, obesity and a number of other poor health outcomes among people of all ages. And it’s not just soda. Other carbonated soft drinks, juice, sport and energy drinks, sweetened milk, tea, and coffee, and other beverages where any type of sugar has been added stand colorfully side by side in the suspect lineup.

Tasha, a fifteen-year old girl I was seeing at our clinic at a family homeless shelter (formerly a motel), stared at the floor as I talked with her about her sore throat and stuffy nose. Toward the end of the conversation, I asked her if anyone had ever talked to her about her weight, which was at the 99th percentile for girls her age.

“Yes. My primary care doctor said I should eat healthier and go to the gym.”

I looked around the stuffy, re-purposed motel room, currently being used as a meeting room, clinic, and storage room. The view from the window was of a large parking lot and cars whizzing by on the neighboring I-95. There was not a gym in sight.

Technology is here to stay. A recent report found that in 2014, there were enough cell phones (7 billion) to cover 96% of the world’s population (some people have more than 1). This includes 90% of people in developing countries, where owning a cell phone is more common that having a landline or computer. Another report by the Pew Research Center found that around 75% of mobile phone owners use text messaging. Diverse populations, including adolescents, people with low income, and those in developing countries, have readily adopted mobile technology and text messaging. As a result, more research has turned to the use of text messaging as a delivery mode for disease prevention or management interventions, especially for these traditionally harder to reach populations. Text messaging has been shown to be a successful tool in smoking cessation and diabetes management, and researchers in the field of obesity prevention have begun to use it with hopes of similar success.Does Text Messaging for Weight Loss Work?

Pregnancy causes remarkable changes in a women's body. Hormones surge, and circulation and metabolism change. A growing body of research suggests that a woman's physiological response to the cardiovascular and metabolic demands of pregnancy may provide a looking glass into her future health. Researchers are becoming more and more convinced that pregnancy serves as a “stress test” that unmasks risk for cardiovascular disease (CVD) later in life.

As a graduate student in nutrition with a particular interest in prenatal diet, I was confident that if I ever became pregnant I would follow a perfect diet. Then I got about six weeks into my first pregnancy. There was no way I was eating fish most days, and vegetables were a struggle. Instead, there were three things that I could reliably eat during my first trimester: pineapple, waffles, and peanut butter. Pineapple is pretty non-controversial, and my doctor said it was perfectly fine to regularly make waffles for dinner (my husband disagreed). However, there seems to be a widespread perception that nut products should be avoided during pregnancy, or at least eaten in moderation. In 2000, the American Academy of Pediatrics advised that “no maternal dietary restrictions during pregnancy are necessary with the possible exception of excluding peanuts."

In July, I attended a workshop on the Healthy Birth, Growth, and Development Initiative organized by the Bill and Melinda Gates Foundation. The workshop brought together experts in nutrition, growth, and statistical modeling to advise the Gates Foundation on its efforts to maximize brain development by interventions during the first 1000 days of life (conception through age 2). What will be their key measure of success?

Even when guidelines are clear, doctors do not always follow national screening guidelines. So how do they behave in situations which may be too unsettled for guidelines to reign? Take the example of cholesterol screening for children. The National Heart, Lung, and Blood Institute (NHLBI) comes on strong and recommends universal screening for those ages 9 to 11 years. The American Academy of Pediatrics (AAP) toes a middle ground, and the U.S. Preventive Services Task Force (USPSTF) just doesn’t believe there’s enough evidence to recommend any pediatric lipid screening. So how often are pediatricians screening for cholesterol levels? The short answer is not very often.

Obesity is the scourge of the 21st century. Carrying extra weight in adulthood causes diabetes and heart disease. In childhood, obesity not only presages adult obesity, but it also leads to asthma, depression, orthopedic problems and other ills among children themselves. Rates of obesity in children and adults are just about as high as they can be in western societies, and they are rapidly increasing in the developing world. By 2030, close to a billion people across the globe will have diabetes or prediabetes.

A colleague and I recently wrote a JAMA commentary that revisited the arguments in favor of menu labeling. People eat large calorie meals when dining at restaurants, and they often don’t know how many calories they are consuming. Calorie labeling provides immediately accessible calorie information at the moment when customers are making decisions. Also, calorie labeling might prompt restaurants to reduce the calories in items, especially those with the most egregious calorie counts (check out Dave’s Hot and Juicy ¾ pounder at Wendy’s or the 12 inch Big Hot Pastrami at Subway, both coming in at over 1000 calories, even before the sides are added on).

Who We Are

Researchers, educators, clinicians, nutrition and wellness experts of the Division of Chronic Disease Research Across the Lifecourse (CoRAL) in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.